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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000359

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Thomas FrederickBlackburn Sex Male

Date of Birth December 4, 1920 Place of Birth HalifaxCounty of Halifax

Name of Father John Hilary Blackburn MAIDEN NAME of Mother Amy Ryan

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Halifax Present address of Father deceased

Occupation of Father at Birth of child Caretaker Place of birth of Father Lower Prospect, Halifax Co.

Race English Name and present address of Physician in attendance at birth Dr. Buckley

Signature of Applicant Mrs. John Howard Address of Applicant 92 Sackville Street, Halifax Date 1 May 1962

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Thomas FrederickBlackburn

Born at Halifax in the County of Halifax

That Thomas FrederickBlackburn Whose Birth is sought to be registered was

born at Halifax Halifax County on December 4, 1920

My knowledge of the fact and date of such Birth is based on the following Circumstances:

Certificate of Baptism, marriage extract

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